Organization
COUNTRYSIDE DRUG COMPANY II
Active
Other names
COUNTRYSIDE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN L STRATTON (CFO)
(989) 352-8168
Entity
Organization
Contact information
Practice address
9695 N GREENVILLE RD, LAKEVIEW, MI 48850-9107
(989) 352-8168
(989) 352-6253
Mailing address
9695 N GREENVILLE RD, PO BOX 527, LAKEVIEW, MI 48850-9107
(989) 352-8168
(989) 352-6253
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301004423
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1756241
—
MI
01
—
2039499
PK
—
Enumeration date
11/07/2006
Last updated
10/16/2017
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